Surgical Treatment for Primary Hyperparathyroidism in Hong Kong

Abstract

Hypothesis: With the introduction of the blood chemistry multichannel autoanalyzer, primary hyperparathyroidism (HPT) is increasingly diagnosed. The clinical pattern of primary HPT has undergone a significant evolution in Western countries. A similar change can be documented in a geographic region where this condition is considered to be relatively uncommon. Design: Unselected case series. Setting: A tertiary referral endocrine surgical unit. Patients: All patients with primary HPT surgically treated over the past 30 years. Main Outcome Measures: The prevalence of patients per 100000 hospital admissions, clinical presentation, biochemistry study results, pathologic status, and main outcome were compared over three 10-year spans according to the introduction of the multichannel au

Changing biochemical presentation of primary hyperparathyroidism

“…Others have reported similar experiences regarding trends in preoperative serum calcium and/or adenoma weight [2,3,5], and adenoma weights in our series were similar to those in contemporary reports [10][11][12] but lower than in earlier series [13]. It is probable that the observed decrease in adenoma weight and preoperative serum calcium levels indicate that patients are operated at an earlier stage of the disease.…”

“…This is contrary to what was found in the study by Lo et al where PTH levels decreased from a mean of 342 pg/ml in 1983-1992 to 155 pg/ml in 1993-2002 [5]. An intriguing explanation could be that the PTH levels reflect adenoma in evolution.…”

“…From being a life-threatening condition with severe skeletal, renal, and cardiovascular complications, pHPT patients during the last decades usually present with mild or no symptoms, often discovered by routine measurement of serum calcium [2][3][4]. Some studies, but not all, have found that patients are operated for smaller adenomas, with lower preoperative PTH and calcium levels [2,5]. Larger adenomas are more likely to be detected preoperatively, i.e., by sestamibi scintigraphy and/or ultrasound [6].…”

Mild Primary Hyperparathyroidism: A Literature Review

“…In Rochester, Minnesota, the total incidence of pHPT treated at theMayo Clinic decreased since its peakin1974-1982; however, the number of parathyroidectomies performed increased over the same period of time at that institution [5]. Outside the U.S., a Hong Kong study found a sevenfold increase in operative pHPT over the past decade [6], in Denmark the diagnosis of pHPT has increased fivefold in women and threefold in men over the past 20 years [7], and in China the percentage of patients with pHPT who were asymptomatic at the time of their diagnosis has increased from ,21% to 52.5% over 10 years [8].…”

Minimally Invasive Parathyroidectomy for Primary Hyperparathyroidism - Current Views, Issues and Controversies

“…(Bilezikian et al 2000;Lo et al 2004;Chen et al, 2010) In contrast, in the Western world, pHPT is a relatively more common disease with an estimated incidence of 42 to 190/100,000 cases per year. Surgical treatment or parathyroidectomy remains the only curative therapy for patients with pHPT.…”